DST (Suture Technique) Asian Double Eyelid Surgery - Natural?

Is the DST (suture technique) asian double eyelid surgery look natural when the eyes are closed? I have heard that there will be a line / fold visible when the eyes are closed, which is not natural looking. Does the incisional method provide more natural looking eyes when the eyes are closed?

Doctor Answers 6

This varies with the eyelid.

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DST can be very natural.  The real issue is longevity, lash ptosis, and lack of customization of how the upper eyelid fold lays on the eyelid platform.  For these reasons, I don't perform DST.  DST is really a method for non-surgeons.  If you have true eyelid expertise, the open method provides a superior method for definitively dealing the eyelid.  However, it requires training, skill, experience, and yes more costly resources than threading a suture.  For this reason DST is very popular in Asian countries.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

It's the technician, not the technique, that is most important.

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There are many different techniques for Asian eyelid surgery and they all have pros and cons. Most reputable surgeons don't just use one technique on every patient. Instead, they first understand what needs be done on their patients and choose the best technique to achieve the goal. 

Seeing a visible "fold/line" can potentially occur with any technique.

It's the surgeon,not the technique, that is most important in achieving a good outcome in Asian eyelid surgery.



Eric In Choe, MD
New York Plastic Surgeon
4.6 out of 5 stars 51 reviews

Natural look with the suture technique

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The suture technique results in very natural looking double eyelid creases. Even with the eyelids closed . The extremely fine sutures provide a gentle compression of the eyelid structures to form a crease from within that is not generally visible unless the eyes are open. Although the suture technique has limitations, for the right candidate it produces extremely natural result with a short recovery time.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 114 reviews

Asian blepharoplasty and visible line when the eyelid is closed

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Having a visible line after asian blepharoplasty is quite common and unavoidable most of the time. You can get an incision less method of creating the crease but in my opinion and the opinion of many other prominent Asian eyelid Surgery Surgeons is that the incision method is less reliable. Dermal levator fixation is the procedure performed by greater than 90% of asian blepharoplasty surgeons. This usually leads to less natural looking eyelids in my opinion. I prefer my technique that was developed by Dr. Park. There is a way to have less scarring and a fold that is more natural.

Philip Young, MD
Bellevue Facial Plastic Surgeon

DST - is it natural looking

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The Double sutures with twisting is an excellent technique for the correct candidate. It requires both eyes to have good function of the eyelid - opening muscle (levator muscle). It does not allow for making the two eyes more symmetric if you have minor differences, and it should not be used if you have any ptosis.

This is a subset of sutures based surgeries which is supposed to have more longevity than other types of suture based surgeries. It was described by Drs. Minami and Kure, plastic surgeons in Japan.

Charles S. Lee, MD
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 79 reviews

Asian Eyelid Surgery Suture Technique

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Morning Natalie84,

The answer is, yes, it looks natural.  Both look very good and very natural in the hands of the right surgeon.  You should go to a facial plastic or oculoplastic surgeon who does this frequently.  My practice is essentially 99% Asian and most of the surgery I do is eyelids.  I use the suture technique frequently, but not as often as the open technique since the open technique last forever vs. suture that can, in some cases, be less permanent.  Here's what you should remember about the suture technique to ensure it lasts and looks great:

1.  When the sutures are placed at the level of the skin some surgeons make the mistake of passing the suture too shallow beneath the skin and it can appear puckered.  

2.  Placing multiple sutures, as is often the case, the surgeon should leave the knot available for adjustment before cutting the excess suture and completing the case.  With the incomplete test knot in place the surgeon can have you open and close your eyes to ensure the tension is correct.

3.  Suture technique can last a very long time.  However, if you wear contacts and pull on the upper eyelid to place them the crease or fold you've created can loosen or pull out over time.

I like both techniques and the suture method is excellent but I do believe the open excision technique will give you the longest lasting result.  On advantage to the suture technique is you'd be ready for the public in 4 to 5 days as long as your bruising is minimal. 

Best of Luck

Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.